Monday, March 20, 2017

Anesthesiology Match--Enough Already

Another Match Day has come and gone. As usual there is plenty of celebrating going on, and rightly so. After four years of incredibly hard work, the end of the tunnel is in sight. Of course that will be followed by an even longer and darker tunnel otherwise known as residency. But we'll forget about that and let the bright eyed students have their moment.

But for us practicing physicians, it behooves us to pay close attention to Match Day too. It can foreshadow trends taking place in our field. And the trend for anesthesiology isn't looking great. For one thing, the supply of anesthesia residencies is outstripping the number of students who want to be anesthesiologists.

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As this chart from the NRMP shows, the number of anesthesia spots filled by U.S. medical students is trending down. This year, only 66.8% of PGY-1 positions were taken by American students. This is down from 73% in 2015 and almost 75% in 2013. The popularity of anesthesiology has held steady for years. This year, 803 U.S. seniors matched into anesthesiology. In the past five years, the number of U.S. matches usually ranged from 750-800. So if the numerator holds steady, that must mean the denominator is exploding. And here it is.

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This year 1,202 PGY-1 positions were offered in anesthesiology residencies. That is up from 1,000 spots available only 2013, a 20% increase in just five years. Then you look at the historical data and it is even more terrifying. In 2008 there were only 666 spaces. So in ten years the number of PGY-1 positions has nearly doubled. If you want to look back even further--

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Imagine that. In 1997, only twenty years ago, anesthesia residencies offered only 317 first year spots. Lest you think that was because of the nadir in anesthesiology interest at that time by medical students, in 1991, during the supposedly halcyon days of anesthesiology, just 329 positions were offered. That was when anesthesiology was truly considered an elite residency and nearly impossible to match into. So we've almost quadrupled the annual supply of anesthesiologists in 25 years.

For comparison, this year the number of categorical surgery positions offered were 1,281. Back in 1997, surgery programs had only 1,009 PGY-1 spots, a much more reasonable 20% increase in two decades since it follows more closely to the increase in general population.

Where are all these new anesthesiologists going to practice later? Already it's almost impossible to find a job after residency without first completing a fellowship. Almost all the anesthesia residents I know now go into some sort of post residency training. Are we all going to fight for scraps with the CRNA's in the OR and Surgical Home leftovers with the hospitalists? Hope all you guys have a side business in botox injection or day trading stocks because the amount of money for anesthesia is not increasing and we keep flooding the supply of anesthesiologists into the healthcare market. 


  1. Wow why do they keep approving more slots. it's ridiculous. soon you'll see anesthesiologists driving ubers

  2. How much of the increase in PGY-1 positions is being driven by the growing trend of programs to switch from advanced (PGY2-4) to categorical (PGY1-4)? Having applied and matched a couple of years ago, I remember noting that the percentage of advanced vs categorical spots on offer has changed dramatically in the last several years. More and more programs are switching from advanced to categorical, and that might be driving some of the increase when just looking at PGY-1 spots offered.